One of the outsourcing giants paid to assess disabled people for their eligibility for benefits appears to have admitted that it is standard practice – approved by the government – to ask claimants with mental health conditions why they failed to take their own lives.
A leading clinical psychologist has warned this week that such questioning “brings huge risks” and is one of the reasons behind the increase in suicides associated with the government’s work capability assessment (WCA) process*.
The admission from Maximus, which carries out WCAs for the Department for Work and Pensions (DWP), came after a disabled campaigner produced a recording of his own assessment.
On the recording, shared with Disability News Service (DNS), a Maximus assessor – an occupational therapist – is heard asking Jonathan Hume a series of questions during his WCA, while typing on a keyboard.
She asks him [his replies have not been included]: “Back to some questions that we have to cover…
“Have you ever tried to harm yourself or take your own life or needed to go to hospital?
“Do you have any thoughts around that at the moment, any intentions or plans to hurt yourself currently?
“When you say desires, how often are you having thoughts like that?
“And what is it that stops you from acting on the thoughts that you have?
“Can you think of any reason that you’re not doing that? Is it friends or family support?”
Hume’s assessment took place in Sunderland last September, and both Maximus and DWP appear to have conceded that the DNS transcription of the questions is an accurate description of what took place.
Hume came forward after fellow disability rights activist Alice Kirby sparked a horrified reaction on social media last week after revealing how the healthcare professional who assessed her eligibility for personal independence payment (PIP) had asked her: “Can you tell me why you haven’t killed yourself yet?”
After she shared her experience, many other claimants came forward to say that they had been asked the same, or a similar, question by their assessors.
Hume said he had raised concerns with Maximus about the questioning by email on the day of his assessment, before he knew the result of his employment and support allowance (ESA) claim.
He told DNS: “As both clinicians and claimants have made clear, the WCA is a hostile, stressful and coercive situation and the carelessness and brutality with which these questions are asked has the potential to do a great deal of harm to vulnerable people, many of whom are already avoiding claiming their rightful benefits due to a system which is degrading and stressful from the first phone call.
“We are forced to justify our very survival in a hostile context to answer questions which are only dubiously related to the legal criteria of ESA.
“Such information, if truly necessary for the claim, could be gained in so many other ways that avoid putting claimants in significant distress and risk, such as written statements from the claimant’s therapists or other carers.
“There are no grounds to continue such questioning.”
Dr Jay Watts, a clinical psychologist and academic, told DNS that people should only be asked about suicidal ideation by a trained professional who can offer help or someone in an “existing trusting relationship with the individual”.
She said that WCAs were “degrading and humiliating experiences for most if not all claimants” and were carried out in a space which was “not a trustworthy one”.
She said: “Individuals are required to parade their distress and feel compelled to answer intrusive questions (for the means to live relies on this).”
She added: “To ask about suicide or self-harm in this context brings huge risks.”
And she said that such questioning “can be suggestive if the environment is unsafe.
“If someone is low or anxious, for example, made to feel they are a ‘skiver’ for needing benefits, an implication that if they were really ill they would have killed themselves can be the final straw. It may lead directly to an attempt on one’s life.”
She said that claimants were “battered with multiple questions about that which is most personal” in disability assessments and questioned about suicide while the assessors are “typing away” on their keyboards.
Watts said: “I have no doubt that questions on suicidal ideation, and the degrading manner in which they are asked, are one reason behind the suicide spike associated with the WCA process.”
She called on Frank Field, chair of the Commons work and pensions committee, to carry out an urgent review of the way disability benefit assessments are carried out.
In a statement, a Maximus spokesman said that its role was “to carry out high quality and sensitive functional assessments”.
He said: “Mr Hulme [sic] contacted us last year and a doctor reviewed the recording of his assessment and the report.
“We are satisfied that the healthcare professional who conducted the assessment did so in line with our policies and guidelines.
“Every healthcare professional we employ is trained to ask people with a mental health condition a series of clinical questions to assess how their condition affects their daily lives.
“The assessment report was passed to the Department for Work and Pensions, who make the decision on eligibility for benefits.”
He had failed to clarify by noon today (Thursday) whether the questions asked of Jonathan Hume were standard questions; if DWP was aware that such questions were being asked in assessments; and whether Maximus and DWP believed that they were appropriate and safe questions to ask of someone in his situation.
Despite requesting a copy of the recording, which was provided by DNS – with Hume’s agreement – DWP also failed to provide clear answers to a series of key questions.
These include whether it accepted that the questions were asked in Hume’s assessment; whether asking such questions was appropriate and safe in an assessment, particularly for assessors who are not trained mental health professionals; and whether these were standard, DWP-approved questions asked of ESA and PIP claimants with suicidal ideation.
Instead, in response to the DNS questions, a DWP spokeswoman said: “We are not aware of any complaints made to DWP on this issue, but would investigate any allegations thoroughly.
“All PIP assessment providers receive training on mental health conditions, including suicidal issues.”
She said that assessors “receive training in order to conduct functional assessments on behalf of the DWP and their training includes conducting a mental health assessment which may, if appropriate, include questions about suicide or self-harm.
“Health professionals are medically qualified professionals and as such, they should have the appropriate skills to enable them to deal with people in a supportive and sensitive way.
“If an individual has mental health issues or a there is an indication of suicidal thoughts or intentions, this will be given careful and sensitive exploration to establish the circumstances.”
She added: “There is a duty of care to act where appropriate, for example if the individual is considered to be in substantial and imminent risk.
“Both the department and our contracted providers have a duty of care where there is any indication or possibility of suicidal thoughts or intentions, and it would therefore not be appropriate to not explore this further.”
Government-funded research by public health experts from the Universities of Liverpool and Oxford concluded in late 2015 that the programme to reassess people on incapacity benefit through the WCA was linked to 590 suicides in just three years. Maximus declined to comment on the research at the time.